HealthDay News — According to a study published in the New England Journal of Medicine, antiretroviral therapy (ART) is associated with significantly lower rates of early HIV transmission, but has a higher risk of adverse maternal and neonatal outcomes for HIV-infected pregnant women.
Mary Fowler, MD, MPH, from the Johns Hopkins University School of Medicine in Baltimore, and colleagues randomized 3490 HIV-infected women at 14 or more weeks of gestation with CD4 counts of at least 350 cells/mm³ to zidovudine and single-dose nevirapine.
This regimen was followed with a 1-to-2-week postpartum “tail” of tenofovir and emtricitabine (zidovudine alone); zidovudine, lamivudine and lopinavir-ritonavir (zidovudine-based ART); or tenofovir, emtricitabine and lopinavir-ritonavir (tenofovir-based ART).
The researchers found that, compared to zidovudine alone, the rate of transmission was significantly lower with ART (0.5% in the combined ART groups versus 1.8%). Compared with zidovudine alone, zidovudine-based ART was associated with a significantly higher rate of maternal grade 2 to 4 adverse events (P=.008).
Tenofovir-based ART correlated with an increased rate of grade 2 to 4 abnormal blood chemical values (P=.03). Birth weight <2500 g occurred more often with zidovudine- and tenofovir-based ART than with zidovudine alone.
“Antenatal ART resulted in significantly lower rates of early HIV transmission than zidovudine alone, but a higher risk of adverse maternal and neonatal outcomes,” the authors write.
One author disclosed financial ties to the pharmaceutical industry.
Fowler MG, et al. “Benefits And Risks Of Antiretroviral Therapy For Perinatal HIV Prevention”. New England Journal of Medicine. 2016. 375(18): 1726-1737. doi: 10.1056/NEJMoa1511691.